Provider Demographics
NPI:1811225006
Name:KURT KODROFF MD PC
Entity Type:Organization
Organization Name:KURT KODROFF MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:KODROFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-529-5059
Mailing Address - Street 1:180 MONTAGUE ST
Mailing Address - Street 2:APARTMENT # 3G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-3607
Mailing Address - Country:US
Mailing Address - Phone:347-529-5059
Mailing Address - Fax:
Practice Address - Street 1:585 SCHENECTADY AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1809
Practice Address - Country:US
Practice Address - Phone:718-604-5789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-26
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210374207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty